Basic Information
Provider Information | |||||||||
NPI: | 1275598104 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CILURSU | ||||||||
FirstName: | ANA | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 E. NEW YORK AVE | ||||||||
Address2: | 4TH FLOOR - SPG | ||||||||
City: | SOMERS POINT | ||||||||
State: | NJ | ||||||||
PostalCode: | 08244 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6093656200 | ||||||||
FaxNumber: | 6099264311 | ||||||||
Practice Location | |||||||||
Address1: | 700 SHORE RD | ||||||||
Address2: |   | ||||||||
City: | SOMERS POINT | ||||||||
State: | NJ | ||||||||
PostalCode: | 082442332 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6093656200 | ||||||||
FaxNumber: | 6099264311 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/20/2006 | ||||||||
LastUpdateDate: | 02/03/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/15/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | MA47711 | NJ | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
ID | Type | State | Issuer | Description | 5074801 | 05 | NJ |   | MEDICAID |